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Home My WebLink About0151 BRACKEN FERN ROAD - Health ogo2 - o �� C TOWN OF BARNSTABLE LOCATION hZ SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ,ASEPTIC TANK CAPACITY /000 'LEACHING FACILITY:(type) {fir (size) �NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER e'BUILDER OR OWNER t Sir , DATE PERMIT ISSUED: �` � DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 2 24 ` e2_ clo 4 F'- THE COMMONWEALTH OF MASSACHUSETTS `, a - 2J O BOAR® OF HEALTH �f ...............%oWn .....-.-...-.OF.....,13... ......................................................... Appliratiou for Bhipoii al Workii Tomitrurtiurt ami# Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: _ z. .1.!� ��....��........��..� ....� .. ......... .....••---...__.LcST.-��-------......---..............------•--------._............-- Location-Address or Lot No. =�av�ee K- ...................... �w►�+h _........_ ................ Owner Address wmmT Y Ale yS9r2 �s ...t!?11.�9s............................................... Installer Address of TypeBuilding ngNo: of Bedrooms �lr.;r _:_.____________________Expansion Attic we) Size Lot_-G Garbage Grinder . feet Dwelling (fib) p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) A4 Other fixtures ___________________________________ W Design Flow_________________________________S5_..gallons per person per day. Total daily flow_:__.__..___.__________._____. o__gallons. WSeptic Tank—Liquid capacity_10-O.O_gallons' Length_ ._--4,t ._ Width_47IQ`_`__ Diameter_______ ______ x Disposal Trencho. .......`_........... Width_____!.............. Total Length______.__.____.__ Total leaching area____.____________ sq. ft. Seepage Pit No.__..cww-------- Diameter.......1-f�....... Depth below inlet.___.�P_........... Total leaching area...j?94�7...sq. ft. Z Other Distribution box (X-) Dosing tank ( ) Percolation Test Results Performed by....Jt_.T a.c-a4at___________________.:__....._________._____ Date.... z s $.________... aTest Pit No. 1.....Z-------minutes per inch Depth of Test Pit-----_7. ........ Depth to ground water______________ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water______ `_ -OF P4 ---•---- ---•------•--•----••--••••-••••--•••-••---•-•-.....--••-----------•••-••-•-•-•••---_-••--•---••-•----•-----------••------• - . -•---•--•-- O Description of Soil...... :: .---7--p'p... -----------•--------------------------------------•-•-.... -STEPHEN (xj - r YYI_�c�►,+r�1 r`� !l.e� ALLYN W ILS WON ....................------•----------•-----•-•---...--••------------•------•----.__-•-------•--••-•----•------------•----------------•---••--•---••------••-----...--•_._._._.. ._.. .....1Rd:30216� V Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc rd ce wit «-oig- the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ------------------ .. Application Approved BY - y..... �... :�� tag .....� 7 �s Date Application Disapproved for the following reasons: ----................ .. .............. ........................................ .. .... ................... .--- --- ----------------------------------------- ------------------------------------------- ---------------- - Date PermitNo. ......... °l-._ 6- ---------------------------- Issued -..--....-...-....-...--...-.-..--....--------------- .--------- Date r... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G,an OF. Gu�fl� t<?... App irFatinn for %gpoiiFai Works Tonstrnr#inn ramit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: I-F ..s. .------=<``'�:-:..''............... .............<.� .�8------. ..._..................................... ,• , - - - ------------- Location-Address or Lot No. Ti.,itca FC �vv► �h . cr /fZCt�/ Owner Address s a '...... .... Installer Address U Type of Building Size Lot..-.Y1,I.._5'4Z....Sq. feet Dwelling—No. of Bedrooms...._►•-hrG�.........................Expansion Attic Wo) Garbage Grinder (�f/o) '4 Other—T e of Building ............................ No. of persons..,................... Showers — Cafeteria Q 1 Other fixtures .................................................... W Design Flow..................................5. '____gallons per person per day. Total daily flow............................... P._gallons. WSeptic Tank—Liquid capacity.A00.0gallons Length_6_-:"'... Width._4.....Z".. Diameter................ Depth_g�&". x Disposal Trench No. .................... Width............,....... Total Length...........r........ Total leaching area....................sq. ft. Seepage Pit No.....c.�....... Diameter........Ltt ...... Depth below inlet.....6........... Total leaching area...' 7...sq. ft. Z Other Distribution box Dosing tank ( ) `" Percolation Test Results Performed by....�1�.. fit. _ca i................•..� .....Date....: 8............ a a/ Test Pit No. 1.....L-_-____minutes per inch Depth of Test Pit-----7_.__....... Depth to ground water--___ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water .CFA#, ai ----•--•....................•.... .-•-•--•••--••••-••-•-•••••-•--•....--•--•••------•••--•----••......_...-----•-••--•......-- S 5 0 - � - TEPH Description of Soil......0.::J ; r`'1" ..1.4?� �� ;kUhSp-Ll.................:....••-•--------------•----•----............-------- AttYi1... ✓1 .........................................................-••---...... U Nature of Repairs or Alterations—Answer when applicable.................................................................... 9Sat4 ______________ __ ____________ __ _ _ _ s �� t install the aforedescribed Individual Sewage Disposal System in acc d Agreement: The undersigned a rees o s ante with ` `��'` the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed . - -. Y.... ---------------------------------------- Date Application Approved BY ------------ s --� a .,,~..'`� j"w.....a -...- (� ....... ,. / Date Application Disapproved for the following reasons- -----------}-------------------------------------- ---------------- -------------- ------------------- -------------------------- --- -------------- - -- -----------. . -- -- -- -- ---------........--...-- .--------..........-- -- --- -•----......---------............-- ...................------. ...---- . ------.--......... . --- Date PermitNo. ......... ..... ................... Issued ................................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1V� mot. .�.._.-...... OF ......-�"�e7,,` . ... ............ . -- .......................... Cgex#Yftrak of (1omplianre THIS IS TO CERTIFY, That the Individual Se age isposa stem onstr-u�Wa ( 4 ) or Repaired%( ) Installer at .. ...T'.........�............... r•, i/............................ r.. . :...✓.......�... .. .............. has been installed in accordance with the provisions of TITLE 5 a The State Environmental Code as described in cj' the application for Disposal Works Construction Permit No. ......... ..../..... g.J�..�?--..--.. dated --...--..................-...---........---..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. /101 DATE-------- ``.. •'... -- -------------- ---------------------- Inspector -- ---...:.....---- ... ----.......--............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - No..�r/--:6Jr-1.... FEE... �. Umpnsa Workii TnnotrndUan rani# t .� • Permission is Y granted � _. e== ` -•---. ----=--��.-•- to Construct ( or Repair ( ) n Individual Sewag! Disposal System j Street as shown on the application for Disposal Works Constructionit No.ef_�._' _ ....................................... ...............w __> / ............. Board of Health DATE- ---� ---------------------------- FORM 1255 HOBBS & WARREN. INS.. PUBLISHERS •i r i t - I i j t f 'i � , , 0Z TES/G/L/ OQTQ 4077' /vb 65:ARJ344664� �i4/D&2 ti %r�513 D4/ A=Z:o W R //�X 3At _ /SS.c�[- Pir�u Ci) �r�oo �qL.L Pit- i r Z SLD�WdLL d,P14- ZL A0.. .\ gO1T7y+7 - a tom. y 7b72k- DeV41- 330 /'9&12c ,Z4rE = //n/: Z �1N Of . STEPHEN I : ALLYN ate+ FUCHARDWILSON A. .p No.30216�p $ MXTER H � • i No.24048 oe S N 50 34XI-9;e n/y6 J,./a�-_o F3/- ov&, IA 57,4 L[- P4,e-. 2/S� Ckh-A/IV& -f3�.h�. 7-0 W ir.4 / /�w. L.) •. /.i�✓. 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